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Personality traits and diabetes incidence among postmenopausal women

Luo, Juhua PhD1; Manson, JoAnn E. MD, DrPH2; Weitlauf, Julie C. PhD3,4; Shadyab, Aladdin H. PhD5; Rapp, Stephen R. PhD6; Garcia, Lorena MPH, DrPH7; Jonasson, Junmei M. PhD8; Tindle, Hilary A. MD, MPH9; Nassir, Rami PhD10; Wactawski-Wende, Jean PhD11; Hendryx, Michael PhD12

doi: 10.1097/GME.0000000000001296
Original Articles

Objective: We examined whether personality traits, including optimism, ambivalence over emotional expressiveness, negative emotional expressiveness, and hostility, were associated with risk of developing type 2 diabetes (hereafter diabetes) among postmenopausal women.

Methods: A total of 139,924 postmenopausal women without diabetes at baseline (between 1993 and 1998) aged 50 to 79 years from the Women's Health Initiative were prospectively followed for a mean of 14 (range 0.1-23) years. Multivariable Cox proportional hazards regression models were used to assess associations between personality traits and diabetes incidence adjusting for common demographic factors, health behaviors, and depressive symptoms. Personality traits were gathered at baseline using questionnaires. Diabetes during follow-up was assessed via self-report of physician-diagnosed treated diabetes.

Results: There were 19,240 cases of diabetes during follow-up. Compared with women in the lowest quartile of optimism (least optimistic), women in the highest quartile (most optimistic) had 12% (hazard ratio [HR], 0.88; 95% confidence interval [CI]: 0.84-0.92) lower risk of incident diabetes. Compared with women in the lowest quartile for negative emotional expressiveness or hostility, women in the highest quartile had 9% (HR, 1.09; 95% CI: 1.05-1.14) and 17% (HR, 1.17; 95% CI: 1.12-1.23) higher risk of diabetes, respectively. The association of hostility with risk of diabetes was stronger among nonobese than obese women.

Conclusions: Low optimism and high NEE and hostility were associated with increased risk of incident diabetes among postmenopausal women independent of major health behaviors and depressive symptoms. In addition to efforts to promote healthy behaviors, women's personality traits should be considered to guide clinical or programmatic intervention strategies in diabetes prevention.

1Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, Bloomington, IN

2Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA

3Veterans Affairs Palo Alto Health Care System, Palo Alto, CA

4Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA

5Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla, CA

6Department of Psychiatry and Behavioral Medicine, Public Health Sciences and Dermatology, Wake Forest School of Medicine, Winston-Salem, NC

7Department of Public Health Sciences, School of Medicine University of California-Davis, Sacramento, CA

8Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden

9Department of Medicine, Vanderbilt University, Nashville, TN

10Department of Biochemistry and Molecular Medicine, University of California-Davis, California, Sacramento, CA

11Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, Buffalo, NY

12Department of Environmental and Occupational Health, School of Public Health, Indiana University Bloomington, Bloomington, IN.

Address correspondence to: Juhua Luo, PhD, Associate Professor, Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, 1025 E. 7th St, Bloomington, IN 47405. E-mail:

Received 13 September, 2018

Revised 3 December, 2018

Accepted 3 December, 2018

Funding/support: The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, and U.S. Department of Health and Human Services through contracts HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN268201600004C. A short list of WHI investigators is in a supplemental file (

Financial disclosure/conflicts of interest: None reported.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (

Online date: January 21, 2019

© 2019 by The North American Menopause Society.